Assessing diagnosis in heart failure: which features are any use?

We assessed the value of symptoms, past history, medications and signs inthe evaluation of patients who might have heart failure secondary to leftventricular systolic dysfunction. An open-access echocardiography servicewas set up to help identify patients with left ventricular systolicdysfunction who might benefit from treatment with anangiotensin-converting-enzyme inhibitor. History and examination wererecorded for each of these patients. The patients were divided into groupsaccording to whether left ventricular systolic function was preserved ornot and whether various clinical features were present or not. Of 259consecutive patients studied, 41 had impairment of left ventricularsystolic function as assessed by echocardiography. Past history ofmyocardial infarction and displaced apex beat were the best singlepredictors of left ventricular systolic dysfunction as assessed byechocardiography. The combination of past history of myocardial infarctionand displaced apex had the best positive predictive value of all. Patientswith such clinical features or combinations of clinical features may notneed echocardiography, and where access to this resource is limited, itcould be reserved for patients without such diagnostic features.